Provider Demographics
NPI:1730863101
Name:HEMMINGER, JAKE PRESTON (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:PRESTON
Last Name:HEMMINGER
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11110 BERKLEY SQUARE LN
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-1255
Mailing Address - Country:US
Mailing Address - Phone:334-318-0607
Mailing Address - Fax:
Practice Address - Street 1:11110 BERKLEY SQUARE LN
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-1255
Practice Address - Country:US
Practice Address - Phone:334-318-0607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30000994235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist